Stressful Life Events and Physical and Psychological Health: Mediating Effects of Differentiation of Self in a Spanish Sample

The pathways between differentiation of self and health remain only partly elucidated. This cross‐cultural study sought to test Bowen's hypothesis about the associations between differentiation, stressful life events, and physical and psychological health, in a sample of 466 Spanish adults. Results show that people with higher levels of differentiation were less prone to physical ailments (e.g., heart disease, cancer, or blood disorders) and psychological symptoms (e.g., depression or anxiety). Further, differentiation mediated the association between stress (i.e., perceived negativity of stress in the past year and number of stressful events across the lifetime) and physical and psychological health. The current research provides cross‐cultural empirical evidence for the links between differentiation and mind and body health in a Mediterranean culture.     

Toward Comprehensive Health Status Measures*

While health, itself, is the central concept in the sociology of health, little agreement exists on what constitutes an appropriate definition of health. This paper develops two composite health status measures (one continuous summary measure, and one set of eight discrete health state measures) based on the World Health Organization's conceptualization of the physical, social, and psychological dimensions of health. Data from a 1978 regional survey demonstrates the continuous summary measure's reliability (alpha = .70), and validity (factor analytic support for the hypothesized dimensions). The results also indicate that although either of the comprehensive measures significantly increase the goodness of fit of structural models of health service utilization, the set of discrete health state measures increases more the goodness of fit, bringing the explained variance of physician visits up from 16 percent to 30 percent. The magnitude of the increments clearly demonstrates the considerable utility of the comprehensive health status measurement approach.     

Mothers and child care: policies,values and theories

Government expansion of child care services is based on the assumption that both parents are employed (the adult worker model) and make cost‐benefit calculations in choosing child care (the rational economic choice model). This paper addresses this assumption, based on research examining mothers' assessments of appropriate child care. These assessments involve complex moral and emotional decisions around their own and their children's needs, and differ between social groups. On this basis, we conclude that the assumptions underlying current child care expansion policy are inadequate, and that the mere expansion of services is not enough.     

Psychological and Physical Health of Nonoffending Parents After Disclosure of Sexual Abuse of Their Child

Disclosure of child sexual abuse can be traumatic for nonoffending parents. Research has shown its impact on mothers’ mental health, which includes heightened psychological distress, depression, and post-traumatic stress disorder. Very little is known, however, about its impact on their physical health or on fathers’ health. The self-perceived mental and physical health of nonoffending parents after child sexual abuse disclosure was compared to determine gender-related differences in this regard. Interviews were conducted with 109 mothers and 43 fathers of 6- to 13-year-old sexually abused children. Bivariate analyses revealed that a fair proportion of parents reported psychological and physical problems after disclosure. However, proportionally more mothers than fathers reported psychological distress, depression, and use of professional services. Fathers were more likely to resort to health services instead of social services and to use medication for depression. Study findings provide leads for health and social service providers for the development of intervention protocols and referral procedures sensitive to gender issues, and they shed new light on specific needs of nonoffending parents.     

Older Lesbians and Gays Accessing Health and Aged-Care Services

Abstract

The present paper examines older lesbian and gay people's experiences of and expectations for the delivery of health and aged-care services. In-depth narrative interviews were conducted with older gays and lesbians in the Blue Mountains, west of Sydney (NSW, Australia). Data were analysed by identifying evaluative statements within specific narratives and grouping these statements into themes. Participants reflected on the meaning of their sexual identity and how they would like it to be acknowledged when in contact with health and aged-care service providers. In addition to direct discrimination, participants reported a more indirect form of discrimination in providers’ assumption of heterosexuality among clients and their failure to provide lesbian- or gay friendly services. The findings highlight the need for health and aged-care services to better understand and acknowledge older gay and lesbian people's sexual identities to enable improved access to services in the future.     

Health System Reform and the Elderly: The Case of Israel

Abstract

Following the implementation of the National Health Insurance Law in January 1995, major changes have taken place in the provision of health services by Israel's sick funds and the way these services are funded. This article presents the principal changes that have occurred and assesses their impact on those aged 65 and older, using findings of a survey conducted one year after the law's enactment. While the findings show that the elderly's situation has improved in some areas, they also raise concerns that the elderly are having difficulty navigating the reformed health system and that they are not benefiting from the new competition among the sick funds.     

Social Inclusion as an Agenda for Mental Health Social Work

Summary

Following New Labour's election to office in the UK in 1997, policy initiatives have proliferated relating to mental health. Much of this policy innovation emphasises the social dimensions of mental health and distress, with an emphasis on employment and social inclusion. Paradoxically, this modernization of the mental health agenda comes at a time when mental health social work is struggling to establish its role and contribution within recently integrated health and social services. The paper considers whether New Labour's flagship programme, Mental Health and Social Exclusion, constitutes a “New Deal” for mental health, and whether it provides a perspective that will help mental health social work to define its distinctive contribution to integrated services.     

Constructing children's psychological well-being: Sources of resilience for children left behind in Northeast China

Population mobility has become an inevitable trend of social transformation in contemporary China. Parental migration has changed family structure patterns and brought great uncertainty to the psychological well-being of left-behind children. By comparing left-behind children to children of non-migrants, this study examines the impact of parental migration on children's psychological well-being and the potential support of schools for children's resilience development along three dimensions: children's school belonging, teacher–student relationships and peer support. Using a mixed-method approach, this study draws on an original survey of children (N = 605) and in-depth interviews with children, parents, grandparents, and teachers (N = 41) in Hunchun City, Northeast China. Overall, maternal migration has a negative impact on children's psychological well-being. In addition to teacher–student relationships, school belonging and peer support significantly mitigate this negative impact; qualitative data further suggest that peer support distracts from, rather than offsets, children's poor psychological well-being associated with maternal migration.     

Chapter 4. Older Latinos and Mental Health Services

SUMMARY

This article discusses the biopsychosocial and spiritual aspects related to older Latinos' use of mental health care. It also addresses the environment that older Latinos have to navigate to access mental health services. Structural barriers to mental health services are emphasized as critical to a holistic assessment of the client's situation.     

Peer Support Among Consumers of Professional Mental Health Services

ABSTRACT

Peer-support services have become increasingly prevalent in mental health; consumers now deliver many services once provided by professional mental health providers. Recognizing this key asset in mental health consumers' service environment is critical for social workers. This exploratory study examines differences among 311 consumers of professional mental health services, half of whom also used peer-support services. The two groups (peer support compared with non-peer-support) were compared on a number of dimensions related to their utilization of and satisfaction with professional mental health services. Users of peer-support services perceived greater availability of professional services and used more professional services, but found professional services to be less useful than those not participating in peer support. No differences between the two groups were found for overall satisfaction with professional services. Findings related to policy, practice, and research are discussed.     

Social Comparisons of Psychological Distress by Boarding House Residents: Self-Evaluations of Mental Health and Healthcare Need

Abstract

Boarding house residents (BHRs), like the wider homeless population, are multiply disadvantaged and have disproportionately high levels of mental ill-health. Social comparison processes that involve comparing one's mental health to others, may lead BHRs to minimize their mental health problems and needs. This cross-sectional study examined BHRs' evaluations of their psychological distress compared to three social reference groups and the significance of these to their felt need for help with distress. Fifty-seven, mostly male, BHRs in New South Wales participated in structured face-to-face interviews that included an objective measure of distress (K10). There was no evidence that psychological distress was underestimated due to social comparison processes. Objective distress produced the strongest prediction of participants' desire for help. Participants reported substantially higher distress than the Australian normative sample and 58% had clinically significant distress. Of these BHRs, 42% indicated that they did not want any help for their distress, which highlights the need for strategies to better engage this group.     

Women's Status,Fertility Decline,and Women's Health in Developing Countries: Direct and Indirect Influences of Social Status on Health

Abstract In the present three‐wave study of 72 developing countries, we use growth curves to examine how changes in fertility and level of fertility mediate the effect of women's social status on women's health as measured by infant mortality, maternal mortality, and female life expectancy. We find that level of female education, average age at marriage, and the percentage of married women using contraceptives influence attained level of fertility, with controls for economic growth and dependency status. Change in fertility, however, is predicted only by average age at marriage and by level of education. Change in fertility, in turn, predicts improvement in all three women's health indicators, while the level of fertility predicts improvement in maternal mortality and infant mortality. In addition to the mediating effects of fertility, both age at marriage and education contribute directly to reduced level of infant mortality; level of primary education contributes directly to reduced levels of maternal mortality; and use of contraceptives contributes directly to improvement in female life expectancy. These findings provide strong evidence that women's social status makes direct contributions to women's health which cannot be attributed to economic growth, dependency status, and/or the mediating effects of level and change in fertility. The policy implication for developing countries is that greater gains can be made in women's health, particularly maternal health, by improving women's social status, especially in rural areas.     

Predictors of employment among sheltered homeless women

The effect of homelessness on the psychological and physical health of women is damaging and long lasting. Understanding of the personal factors that enable homeless women to secure employment and re-enter mainstream society is of utmost importance. A sample of homeless women residing in a US Midwestern nonprofit treatment and transitional living shelter for homeless women and their children were surveyed regarding the extent to which life satisfaction, social self-efficacy, and hopeful thinking predicted women's expected capabilities to obtain employment above and beyond social support provisions, while controlling for participants' age, ethnicity, and education level. Findings failed to reveal that social psychological (i.e., life satisfaction and social self-efficacy) and intrapersonal (i.e., hope) variables predicted homeless women's job procurement self-efficacy above and beyond perceived social support. The social support provision of social integration and younger age significantly predicted women's self-efficacy to secure employment. Implications of results for social justice initiatives and interventions are discussed.     

Emulating Parental Levels of Taking Conflict Personally: Associations with Behavioral and Mental Health Outcomes in Adult Children

Taking conflict personally (TCP) is a construct that measures individuals’ tendency to perceive conflict as a personal attack and focus less on the content of a conflict. This study examined parent–child transmissions of the six dimensions of TCP, as well as the relationship between adult child TCP and their conflict communication, depressive symptoms, and anxiety. Data were collected from 110 (N = 330) mother–father–child triads. The results showed significant links between father-child reports of persecuted feelings (i.e., belief that others intentionally provoke conflict) and stress reactions (i.e., psychological reaction) during conflict. There were also significant links between mother–child reports of positive and negative relational effect (i.e., belief that conflict benefits/damages relationships). Adult children’s reports of four of the six TCP dimensions were associated with their depressive symptoms and anxiety, and the results showed significant indirect effects from parent TCP to adult child verbal aggression, constructive conflict, depressive symptoms, and anxiety.     

Exposure to Client Trauma,Secondary Traumatic Stress,and the Health of Clinical Social Workers: A Mediation Analysis

While it is widely acknowledged that providing services to traumatized populations may negatively impact the mental health of clinicians, little is known about the impact of exposure to traumatized clients and secondary traumatic stress on the physical health status of clinicians. As such, the twofold purpose of this study was to: (1) document the prevalence of STS in a national (US) sample of clinical social workers, and (2) to examine the relationships between exposure to client trauma, STS, and perceived health of clinical social workers. Specifically, we sought to determine if STS mediates the relationship between exposure to client traumas and perceived health. Results indicate clinicians experience intrusion symptoms most frequently, and a significant portion report arousal and avoidance symptoms. Mediation analyses revealed that exposure to traumatized client populations indirectly influenced clinical social workers’ physical health perceptions by way of secondary traumatic stress. Findings call for increased attention toward prevention and amelioration of secondary traumatic stress symptomology among direct service providers, given both its prevalence and potential impact on physical health. Directions for future research are discussed.     

One Hundred Years of College Mental Health

Abstract

Although the first student health service is credited to Amherst College in 1861, almost 50 years passed before Princeton University established the first mental health service in 1910. At that time, a psychiatrist was hired to help with student personality development. Although other schools subsequently established such services, the first 50 years of college mental health were marked by a series of national conferences. At the American Student Health Association's annual meeting in 1920, “mental hygiene” was identified as critical for college campuses to assist students to reach their highest potential. However, it took another 40 years before mental health and psychological counseling services became common on college and university campuses. The American College Health Association formed a Mental Health Section to serve mental health professionals in 1957, and most colleges and universities have now developed mental health and counseling programs commensurate with the size of their student bodies.     

‘Let's Talk About Children’: Investigating the Use of a Family‐focused Intervention in the Gambling Support Services Sector

The family‐focused mental health intervention, ‘Let's Talk About Children,’ has positively influenced the lives of families affected by parental mental illness. This paper outlines the use of this brief, strengths‐based intervention for parents with gambling and other co‐occurring issues from the gamblers’ support services sector. Over a six‐month period, a training manual and accompanying resources were adapted for the gamblers’ support services sector and a targeted training session developed. Nine problem gambling counsellors from three Victorian gambling support services trialled the Let's Talk About Children intervention over a four‐month period. Qualitative data were gathered through focus groups, interviews, and practice enquiry groups to determine the impact of the Let's Talk About Children model for gambling support services. The results are presented as ‘practice wisdoms and recommendations’ reporting on the impact of the trial and to provide some guidance to support others in the implementation of a specific family‐focused intervention. This paper reports on the first exploratory trial of Let's Talk About Children for the gambler's support services sector in Australia.     

Men's Reproductive and Sexual Health

Abstract

A broad definition of men's reproductive and sexual health (MRSH) includes medical (pathophysiological) matters such as sexually transmitted infections (STIs), developmental anomalies, malignancy, trauma, and infertility. It also includes psychosocial concerns: sexuality, contraception, disease prophylaxis, developmental and lifecycle issues, tobacco and drug use, sexual identity and orientation, and partnership issues. College men, of whom a large majority are sexually active, have a range of MRSH needs, including some that are particular to their age and social environment. To reach men effectively requires approaches that are somewhat different from those used with women. Clinicians in college health services are in an excellent position to help young men recognize the importance of reproductive health and sexual responsibility. College health services therefore should offer men screening; clinical diagnosis and treatment for MRSH conditions; and information, education, and counseling services, in a manner designed to meet their unique needs.     

Medicare and Health Care Reform

Although Medicare constitutes one of the most popular programs of the federal government, even its most ardent supporters would likely agree that improvements could be made and likely should be part of any package of comprehensive health care reform. While some changes could be made as stand-alone reforms. it would be better to integrate changes for the under 65-population with those for the Medicare program. For example, cost-containment strategies would work best if they applied to the population as a whole rather than creating differences that lead to cost-shifting and possible discrimination across groups. The generosity of services covered also ought to be balanced between Medicare and whatever happens elsewhere. This would allow Medicare's cost-sharing structure to be less severe in terms of hospital and skilled nursing care, for example. Finally, while it is tempting to use reductions in spending on Medicare as a means for helping to finance other expansions, the impact of such changes needs to be carefully assessed before assuming that they would create no lasting problems. This essay examines some of the options and likely consequences for Medicare as part of comprehensive health reform.